Highlights
- •Venous thromboembolism (VTE) recurrence is a major concern after a first episode.
- •The optimal duration of oral anticoagulant therapy (OAT) after VTE is debated.
- •D-Dimer positivity after OAT is associated with a higher risk of recurrence.
- •Positive D-Dimer has better diagnostic accuracy for recurrence after provoked VTE.
- •D-Dimer testing may drive decisions on OAT duration after VTE.
Abstract
Objective
Venous thromboembolism (VTE) recurrence is a major concern after a first symptomatic
episode, potentially impacting survival and healthcare needs in community, hospital
and rehabilitation settings. We evaluated the association of D-Dimer positivity after
oral anticoagulant therapy (OAT) discontinuation with VTE recurrence.
Methods
PubMed, Web of Science, Scopus and EMBASE databases were systematically searched.
Differences were expressed as Odds Ratio (OR) with 95% confidence intervals (95%CI).
Pooled sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR),
and summary ROC (sROC) curve were calculated.
Results
Twenty-six articles on 10,725 VTE patients showed that the absolute risk of recurrence
was 16.1% (95%CI: 13.2%-19.5%) among 4,049 patients with a positive D-Dimer and 7.4%
(95%CI: 6.0%-9.0%) in 6,676 controls (OR: 2.1, 95%CI: 1.7-2.8, P<0.001), with an attributable
risk of 54.0%. sROC curve of the association between positive D-Dimer and recurrence
showed a diagnostic AUC of 63.8 (95%CI: 60.3-67.4), with a pooled sensitivity of 54.3%
(95%CI: 51.3%-57.3%), specificity of 64.2% (95%CI: 63.2-65.1), PLR of 1.53 (95%CI:
1.37-1.72), and NLR of 0.71 (95%CI: 0.60-0.84). Subgroup and meta-regression analyses
suggested that a positive D-Dimer may have a higher discriminatory ability for patients
with provoked events, confirmed by better pooled diagnostic indexes for recurrence
and a diagnostic AUC of 70.6 (95%CI: 63.8-77.4). Regression models showed that the
rate of OAT resumption after the evidence of D-Dimer positivity was inversely associated
with VTE recurrence (Z-score: -3.91, P<0.001).
Conclusions
D-Dimer positivity after OAT may identify VTE patients at higher risk of recurrence,
with a better diagnostic accuracy for provoked events.
Keywords
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Article info
Publication history
Published online: April 29, 2021
Accepted:
April 7,
2021
Received in revised form:
April 2,
2021
Received:
January 4,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
